Journal of Foot & Ankle Surgery最新文献_第8页

Secondary Surgery Following Lapidus Bunionectomy Lapidus 拇趾外翻切除术后的二次手术。

IF 1.3 4区医学

Journal of Foot & Ankle Surgery Pub Date : 2024-06-22 DOI: 10.1053/j.jfas.2024.05.011

{"title":"Secondary Surgery Following Lapidus Bunionectomy","authors":"","doi":"10.1053/j.jfas.2024.05.011","DOIUrl":"10.1053/j.jfas.2024.05.011","url":null,"abstract":"<div><div>While the Lapidus bunionectomy is a common procedure utilized to address hallux valgus, the incidence of secondary surgery is not well established. Our primary goal was to determine the incidence of revision surgery and hardware removal following the Lapidus bunionectomy in addition to the risk factors associated with each. A retrospective nested case-control study of adult patients who underwent a Lapidus bunionectomy for symptomatic hallux valgus over a 9-year period was performed. The incidence rates and 95% confidence intervals (CI) of secondary surgery in the 3 years following the procedure along with the estimated independent associations and odds ratios between baseline demographic, clinical, and radiographic characteristics were calculated. Of the original cohort of 2540 patients, 127 were identified (5.0%; CI: 4.1%, 5.8%) who underwent revision surgery and 165 (6.5%; CI: 5.5%, 7.5%) who underwent hardware removal following Lapidus bunionectomy. Initially, the hallux valgus angle, intermetatarsal angle, and tibial sesamoid position were risk factors for revision surgery. However, in adjusted analyses for revision surgery, using a screw for third point of fixation emerged as the only independent risk factor (odds ratio [OR] = 3.01; CI: 1.59, 5.69). In adjusted analyses for hardware removal, female sex (OR = 2.33; CI: 1.08, 5.00) and third point of fixation (OR = 2.92; CI: 1.82, 4.69) emerged as independent risk factors. While the overall risks associated with Lapidus bunionectomy are low and the need for revision surgery are low, this study helps to identify specific risk factors for secondary surgery and hardware removal to help in evaluation and discussion with patients.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Applicant Perception and Content Exploration of the 2024 podiatric Residency Interview Process 申请人对 2024 年足科住院医师面试过程的看法和内容探讨。

IF 1.3 4区医学

Journal of Foot & Ankle Surgery Pub Date : 2024-06-22 DOI: 10.1053/j.jfas.2024.06.006

{"title":"Applicant Perception and Content Exploration of the 2024 podiatric Residency Interview Process","authors":"","doi":"10.1053/j.jfas.2024.06.006","DOIUrl":"10.1053/j.jfas.2024.06.006","url":null,"abstract":"<div><p><span><span>Considerable resources are dedicated on an annual basis to the podiatric medicine and surgery residency interview by both students and programs. Despite this, relatively little is known about student perception of the process, nor the format and content of interview. The objective of this investigation was to study and organize experiences of fourth-year podiatric medical students following the 2024 Centralized Residency Interview Program (CRIP) process. An anonymous and voluntary survey was developed and made available to fourth year podiatric medical students. It was relatively common for there to be academic, social/personal, case work-up, and rapid-fire academic question components to the interview. It was also very common to be provided with the opportunity to ask programs questions. It was relatively uncommon for there to be ethical/moral questions, personality/psychologic assessments, logic assessments, and hands-on demonstrations. The most common hands-on demonstrations were suturing, hand ties and performance of fixation principles. Relatively high yield academic topics included plain film radiography interpretation, rearfoot/ankle osseous trauma, </span>diabetic foot infection, advanced imaging interpretation, and fixation constructs/principles. When evaluating programs, students placed high value on surgical volume, surgical variety, relative resident </span>autonomy<span><span><span>, program location, exposure to outpatient clinics, </span>salary, future connections as a program alumnus, unique off-service rotations, exposure to business management/coding/billing, </span>scope of practice<span>, exposure to inpatient management, resident salary, and who the senior co-residents would be. The results of this investigation provide unique information for both medical students and residency programs with respect to the perception, format and content of the podiatric residency interview process.</span></span></p></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Analyzing Learning Curve Effects: Total Ankle Replacement Design Switch and Long-Term Survival 分析学习曲线效应：全踝关节置换术的设计转换与长期生存。

IF 1.3 4区医学

Journal of Foot & Ankle Surgery Pub Date : 2024-06-22 DOI: 10.1053/j.jfas.2024.06.002

{"title":"Analyzing Learning Curve Effects: Total Ankle Replacement Design Switch and Long-Term Survival","authors":"","doi":"10.1053/j.jfas.2024.06.002","DOIUrl":"10.1053/j.jfas.2024.06.002","url":null,"abstract":"<div><p><span>Different aspects of the learning curve in total ankle replacement<span><span> (TAR) have been studied in the short to mid-term, with 30 cases often considered critical. However, its impact on long-term (10- and 15-year) survival remains unclear. Therefore, we retrospectively analyzed 77 consecutive TARs performed by one orthopedic surgeon. The main outcome was long-term survival between cases 1-30 and 31-77 using the Kaplan-Meier with Competing Risk Analyses<span>. Secondarily, we used Moving Average Method with LOESS regression to confirm the learning curve based on the perioperative complications. Thirdly, associations between perioperative complications and operation time on long-term survival were assessed using Cox </span></span>proportional hazard models. The 10-year survival of cases 1-30 was 89.9% (95% CI 70.4-96.5), and of 31-77, 92.4% (95% CI 7745- 97.5) (</span></span><em>p</em> = .58). The 15-year survival was 81.8% (95% CI 59.5-91.8) and 74.8% (95% CI 52.4-86.6), respectively (<em>p</em> = .97). The long-term survival rate for the TAR that endured perioperative complication was 96.70% (95% CI 90.28-103.12), and for the uncomplicated TAR 87.50% (95% CI 77.12-97.88%) (<em>p</em> = .24). Operating time nor occurrence of perioperative fractures were significantly associated with long-term survival (<em>p</em> = .11 and 0.26, respectively). However, moving average method revealed a significant decreasing trend with a cut-off value of 33 procedures regarding the marginal probability of perioperative osseous complications (<em>p</em><span><span> < .01). In conclusion, surgeons should note a learning curve when adapting arthroplasty procedures. After the </span>prosthesis design switch, the learning curve regarding perioperative osseous complications was confirmed at 33 TAR. The switch did not affect long-term survival.</span></p></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Biomechanical Consequences of Proximal Screw Placement in Minimally Invasive Surgery for Hallux Valgus Correction 微创手术矫正足外翻中近端螺钉置入的生物力学后果。

IF 1.3 4区医学

Journal of Foot & Ankle Surgery Pub Date : 2024-06-22 DOI: 10.1053/j.jfas.2024.06.007

{"title":"Biomechanical Consequences of Proximal Screw Placement in Minimally Invasive Surgery for Hallux Valgus Correction","authors":"","doi":"10.1053/j.jfas.2024.06.007","DOIUrl":"10.1053/j.jfas.2024.06.007","url":null,"abstract":"<div><div>Hallux valgus is one of the most common surgically corrected forefoot deformities. Studies evaluating clinical outcomes of minimally invasive chevron and akin (MICA) procedure have shown shorter operation time, faster recovery, and smaller scars compared to the open approach. Previous biomechanical cadaveric studies have largely focused on the open approach with minimal on MICA. To our knowledge, no studies have compared different proximal screw placements in MICA which can either be three-point fixation or intramedullary. This study aims to compare the biomechanical properties of fixation between these 2 techniques in MICA. Six matched pairs of human fresh frozen cadaveric feet were randomized to either 3-point fixation or intramedullary groups. Both procedures were performed by a single fellowship-trained orthopedic foot and ankle surgeon. Using a material testing machine, each specimen underwent 1000 cycles of plantar-to-dorsal uniaxial loads from 0 to 31 N in cantilever configuration while monitoring bending stiffness and distal fragment dorsal angulation. They were then subjected to load until failure at a compression rate of 10 mm/min. Specimens from both groups tolerated the walking fatigue test. Mean bending stiffness of 3-point fixation was 84% higher than intramedullary constructs (<em>p</em> = .002). Mean dorsal angulation of intramedullary was thrice that of 3-point fixation constructs (<em>p</em> = .008). Mean load to failure of 3-point fixation was 30% higher than intramedullary constructs (<em>p</em> = .001). Three-point fixation provide superior biomechanical stability compared to intramedullary proximal screw placement. The surgical technique using 3-point proximal screw fixation can offer robust fixation and lead to better clinical outcomes.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Treatment for Lateral Ray Polydactyly with Brachydactyly of the Foot 多指畸形伴足畸形的治疗方法。

IF 1.3 4区医学

Journal of Foot & Ankle Surgery Pub Date : 2024-06-22 DOI: 10.1053/j.jfas.2024.06.003

引用次数: 0

Open Ankle Fractures in Older Individuals: A Multi-center Study 老年人开放性踝关节骨折：一项多中心研究

IF 1.3 4区医学

Journal of Foot & Ankle Surgery Pub Date : 2024-06-22 DOI: 10.1053/j.jfas.2024.06.001

{"title":"Open Ankle Fractures in Older Individuals: A Multi-center Study","authors":"","doi":"10.1053/j.jfas.2024.06.001","DOIUrl":"10.1053/j.jfas.2024.06.001","url":null,"abstract":"<div><div>The purpose of this study is to identify demographics, etiology, comorbidities, treatment, complications, and outcomes for older patients with open ankle fractures. Patients ≥60 years old who sustained an open ankle fracture between January 1, 2004 and March 31, 2014 at 6 Level 1 trauma centers were retrospectively reviewed. Univariate analysis using chi-squared or Student's <em>t</em> test was performed to identify associations between preoperative variables and 2 postoperative outcomes of interest: amputation and 1-year mortality. Multivariate analysis was performed using stepwise logistical regression to identify independent predictors of postoperative amputation and 1-year mortality. Of the 162 total patients, the most common mechanism of injury was a ground-level fall (51.9%). The most common fracture types were bimalleolar fractures (52.5%) followed by trimalleolar fractures (26.5%), with 41.5% of the fractures classified as Gustilo Anderson Classification Type 2 and 38.6% classified as Type 3A. The average number of surgeries required per patient was 2.1. Complications included: 15.4% superficial infection rate, 9.9% deep infection rate, and 9.3% amputation rate. The 1-year mortality rate was 13.6% and the overall mortality rate was 25.9%. Male gender and fracture type were found to be independent predictors for amputation after surgery (<em>p = .009, .005,</em> respectively). Older age and having diabetes were independent predictors for 1-year mortality after surgery (<em>p = .021, .005</em> respectively). Overall, open ankle fractures in older individuals were associated with high rates of amputation and mortality.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cover 1 -- cover prints black and PMS 261 封面 1 -- 封面印黑色和 PMS 261

IF 1.3 4区医学

Journal of Foot & Ankle Surgery Pub Date : 2024-06-20 DOI: 10.1053/S1067-2516(24)00099-1

引用次数: 0

Subscription Information 订阅信息

IF 1.3 4区医学

Journal of Foot & Ankle Surgery Pub Date : 2024-06-20 DOI: 10.1053/S1067-2516(24)00101-7

引用次数: 0

Medical Malpractice Litigation Following Hindfoot Arthrodesis 后足关节置换术后的医疗事故诉讼。

IF 1.3 4区医学

Journal of Foot & Ankle Surgery Pub Date : 2024-06-13 DOI: 10.1053/j.jfas.2024.05.012

{"title":"Medical Malpractice Litigation Following Hindfoot Arthrodesis","authors":"","doi":"10.1053/j.jfas.2024.05.012","DOIUrl":"10.1053/j.jfas.2024.05.012","url":null,"abstract":"<div><p>Given high patient expectations in the setting of complex surgeries, orthopedic surgeons are at risk of being subject to malpractice claims which can impose significant economic and psychological burden. This study investigates malpractice claims against orthopedic surgeons and podiatrists performing hindfoot arthrodesis and determine factors associated with plaintiff verdicts and settlements using the Westlaw legal database. The database was queried for all cases involving hindfoot arthrodesis using the terms “malpractice” and either “ankle fusion,” “arthrodesis,” “subtalar fusion,” “tibiotalar fusion,” “tibiotalocalcaneal fusion,” “TTC fusion,” or “tibiofibular fusion” from 1987 to 2023. Data regarding patient demographics, causes cited for litigation, case outcomes, and indemnity settlements were collected. Cases were excluded if the defendant was not an orthopedic surgeon or a podiatrist, the procedure involved was not a hindfoot arthrodesis, or if the patient was a minor. Forty-five cases of hindfoot arthrodesis met the inclusion criteria. The mean plaintiff age was 51.5 ± 13.8 years with 51.1% male. Thirty-three cases (73%) were in favor of the defendant, with an average inflation-adjusted payout of $853,863 (±456,179). The most alleged category of negligence was procedural/intraoperative error (75%) followed by postsurgical error (38%) and failure to inform (31%). The most common specific damages included functional/ROM limitation (49%), need for additional surgery (47%), continuing/worsened pain (27%), and nonunion/malunion (29%). Given the frequency of hindfoot arthrodesis performed, this study highlights the importance of effective communication with patients concerning potential postoperative complications, prognosis of their injury, and risks and benefits associated with each treatment modality.</p></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141328088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Long-Term Outcomes of Hallux Amputations at Various Anatomic Levels 不同解剖层次拇指外翻截肢的长期疗效

IF 1.3 4区医学

Journal of Foot & Ankle Surgery Pub Date : 2024-06-13 DOI: 10.1053/j.jfas.2024.05.016

{"title":"Long-Term Outcomes of Hallux Amputations at Various Anatomic Levels","authors":"","doi":"10.1053/j.jfas.2024.05.016","DOIUrl":"10.1053/j.jfas.2024.05.016","url":null,"abstract":"<div><p><span><span>Hallux amputations have long been performed for the definitive treatment of hallux </span>osteomyelitis<span> resulting from ulcerations<span>. These amputations have been performed at various levels of the hallux. The aim of this study is to assess the long-term outcomes in patients with hallux amputations performed at these various levels and to determine whether there is an ideal anatomic level that would limit post-operative complications and need for revisional surgery. An Institutional Review Board (IRB)-approved retrospective chart review of 148 feet with hallux amputations performed at various levels from July 1, 2013 to July 16, 2020 at an academic medical center was conducted. A 2-year minimum follow up was required for inclusion in the study. Incidence of re-ulceration, need for further amputation, healing of index procedure, and revascularization<span> status were evaluated. Statistical analysis utilizing chi square analysis was performed to calculate </span></span></span></span><em>p</em><span>-values where <.05 was statistically significant. In this retrospective study with a minimum of 2-year follow-up, there was a tendency for amputations performed at the level of the head of the proximal phalanx<span><span> (21%) to have a lower rate of reulceration (24%) followed by amputations performed at the level of the metatarsophalangeal joint and </span>interphalangeal joints (36%). However, neither proved to be statistically significant.</span></span></p></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141328087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0